July, 2014

Children  learn  to  communicate  from  

Engaging  families  to  interact  using   interac;ons  with  family  and  friends  
AAC:  What  have  we  learned?      
Gayle  Porter  &  Linda  Burkhart  

Gayle  Porter  is  the  developer  of  PODD  and  receives  royal;es  from  sales  of    
PODD  template  resources.    Gayle  Porter  and  Linda  Burkhart  are  paid  honorariums  for  
delivery  of  PODD  and  other  trainings.  

Your  child  needs  to  learn  to  communicate  

using  AAC  
Selec;ng  an  AAC  system  

Interac;on  is  cri;cal  for  communica;on   Families  learning  to  communicate  using  
and  language  development   AAC  
•  Family  and  friends  will  con;nue  to  be  the  cri;cal  influence  
on  the  child’s  communica;on  and  language  development.    
•  However,  these  interac;ons  will  now  also  need  to  
incorporate  the  use  of  alterna;ve  forms  of  communica;on.  

•  Immersion  in  the  alterna;ve  form  effec;vely  supports  

children  learning  to  use  AAC  
 

–  Parents  are  faced  with  learning  to  communicate  in  a  foreign  

form  that  they  have  most  likely  never  experienced  or  seen  used  
by  competent  users  of  AAC.  
 

–  Natural  interac;on  paNerns  may  be  compromised  as  parents   “An  environment  which  supports  the  acquisi4on  of  alterna4ve  language  forms  
aNempt  to  manage  a  new  AAC  system.     does  not  seem  to  come  naturally.”                              von  Tetzchner  &  Grove,  2003,  p.  13    
   

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 1
 July, 2014

“No  one  taught  me  to  communicate,    I   Families  learning  to  be  users  of  AAC  
just  learned  it”      
(Kim  at  13  years  old).       •  In  order  to  create  an  aided  language-­‐learning  
  environment,  families  need  to  develop  fluency  
using  the  system.      

•  Since  there  typically  is  not  an  immersion  

environment  readily  available  for  the  adults  
learning  to  use  AAC,  they  need  to  be  taught  in  
a  more  direct  and  graded  manner.  

How  do  we  help  families  learn  to  use  AAC?   How  do  we  help  families  on  this  journey?  
•  “Because  communica4on  partners  must  learn  to  alter  well-­‐ •  Shared  understanding  
established  pa?erns  of  interac4on,  successful  training  
requires  understanding  and  guided  prac4ce.”   •  Insight  –  complex  communica;on  needs  
                         Blackstone  1999,  p.  4    
•  Mo;va;on  –  Why?    
•  “It  is  important  to  keep  in  mind  that  people  have  lots  of  
interests  and  responsibili4es  to  juggle.  If  partners  do  not  have   –  see  how  using  AAC  can  add  to  my  child  &  families’  life  
the  4me,  the  resources  or  the  desire  to  change  their   –  Long  term  implica;ons  for  my  child’s  future  
behaviors,  they  won’t.  Thus,  whenever  you  sense  resistance,  
ask  about  it,  and  then  listen  very,  very  carefully  to  what  you   •  Knowledge  of  possibili;es  
are  being  told.”    
                       Blackstone  1999,  p.  4   •  Guided  prac;ce  to  develop  competent  use  of  
  AAC  (sufficient  skills,  knowledge  and  judgment)  
•   “having  sufficient  informa;on  for  collabora;on”    
                 Goldbart  &  Marshall  2004,  p.  202   •  Prac;cal  ideas  and  support  for  juggling  it  all  

Parent  educa;on  sessions  

Early  childhood  service   •  What  is  Cerebral  Palsy?  

•  The  CPEC  Program  
•  Parent  educa;on  sessions    
•  Developing  your  child’s  communica;on  
•  Day  care  &  Kindergarten  staff  educa;on   •  Using  AAC  at  home  
sessions   •  Key  Word  Sign  &  Gesture    
•  Sensory  processing  challenges  
•  Ongoing  modeling  and  coaching  during    

–  Parent  and  child  group  programs   •  Other  specific  topics  

–  Juggling  it  all  –  learning  to  operate  a  SGD  
–  Home  visits   –  Accomplicing  your  child’s  communica;on  
–  Day  care,  kindergarten  visits   –  etc  

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 2
 July, 2014

Developing  your  child’s  communica;on  session   Developing  your  child’s  communica;on  session  
•  Beliefs,  concerns  and  ques;ons  (asked  or  not)  influence   •  Provide  insight  into  their  child’s  communica;on  
uptake  of  AAC,  understanding  of  communica;on   requirements  
•  Aim  to  develop  a  shared  understanding  of  important   •  Inspire  
concepts     –  recognise  possibili;es  for  their  child  to  become  an  autonomous  
–  Communica;on  is  mul;-­‐modal,  we  all  use  AAC   communicator  
–  Communica;on  is  complex    

–  Communica;on  for  varied  purposes   •  Mo;vate  to  use  AAC  

–  Interac;on  of  child  and  partner  in  typical  development  of   –  understanding  of  why  autonomous  communica;on  is  important  
communica;on  and  speech   to  their  child  and  family.    
–  Why  child  with  CP  might  have  difficulty  learning  to   –  Needs  to  be  important  to  make  the  effort  required  by  the  family  
communicate,  develop  speech   to  learn  to  use  a  different  form  of  communica;on  
–  AAC  will  not  prevent  speech  development  
•  Understand  it  will  take  input  before  their  child  begins  to  
–  What  is  important  to  their  child  is  autonomous  communica;on   use  the  system  
–  Learning  communica;on,  language  &  speech  happens  during  
genuine,  daily  life  interac;ons  and  takes  ;me   –  Interac;on,  not  an  aid,  supports  children  learning  
communica;on  and  language  

Communication Communication
Creation of shared meaning

Co-constructed
Understanding Expression

Communication is complex
Communication
•  Sensory
•  Motor
•  Cognitive Understanding
•  Pragmatic &
–  Social emotional Expression
–  Functional uses
–  Conversation skills
•  Language
All these skills are
–  Semantics (word meanings) integrated together for
communication
–  Syntax (grammar)

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 3
 July, 2014

Sensory Movements for communication

•  Understanding others •  Facial expression
–  Hearing •  Body language
–  Auditory processing •  Gesture (sign)
–  Vision •  Speech
–  Muscles of respiration - Airflow
–  Larynx (vocal cords) - Voice
•  Feedback to learn to express self –  Soft palate - resonance
–  Hearing / auditory processing –  Jaw, tongue, lips/cheeks - articulation
palate (speech sounds)
–  Feedback from body
•  Position and movement
•  Writing
•  To use communication aids
–  (Vision)

Clear Connected speech Practice producing speech sounds

requires sufficient
•  Feel how little changes in the position of
•  Speed, range, accuracy, strength, grading, articulators changes the word produced
co-ordination and rhythm of movement of
the muscles for respiration, vocalisation, –  Short vowel /a/ and /e/ difference between
intonation and articulation. “bad” and “bed”

–  Tongue position to co-articulate “park” “peek”

Single sound
–  Sounds may be produced differently,
Syllable “amamama” using jaw movements
Word
Sentence •  Being able to say a sound in one word context, may
not mean you can say in all word contexts

Pragmatics
Varied communication functions
(social use of communication)
•  Use of language, vocalisation, gesture, facial greet manipulate relate information
expression, eye-contact, body movement agree / disagree answer ask questions
•  Appropriateness of communication
•  Taking turns in interaction
instruct others ask for things joke
•  Initiating communication express an opinion share information
•  Feedback to partner
•  Repairing communication breakdown express feelings protest describe
•  Selecting, introducing, maintaining, changing topics
•  Changing communication to suit different
discuss interest "make social contact" bargain
partners, situations & social roles comment request / attract attention complain
•  Use of communication for different purposes

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 4
 July, 2014

Language
•  Language is made up of socially shared rules that
include the following:
–  What words mean (e.g., "star" can refer to a bright
object in the night sky or a celebrity) - Semantics How do children typically
–  How to put words together (e.g., "Peg walked to the new
store" rather than "Peg walk store new") – Syntax develop communication,
–  How to make new words (e.g., friend, friendly, unfriendly)
Word morphology
language and speech?
•  Language is different from speech. Language may
be in a variety of forms
–  Spoken language (speech)
–  Written language
–  Sign language
–  Graphic symbol / Pictograph language

Typical development of
Typical development of communication
communication
•  Explain the typical development of communication, •  Typical sensation and movement
speech and language •  Innate skills – spontaneous development
•  Early communication •  Responses and movements familiar to partners
•  Gestural /vocal communication
•  Spoken language communication •  Early communication
•  Emphasise the interaction of child and partner •  Newborns innately interested in faces
behaviours in this development •  People speak to infants from birth (intonation
patterns attract attention)
•  At CPEC, children have mild to severe movement •  People interpret meanings of infants body
challenges, so we also emphasise the sensory and motor movements, crying etc
skills that enable this development •  Infant smiles or coos in response to other
people’s speech (1-4 months)

Typical development of communication Typical development of communication

•  Early communication (cont)
•  Gestural / vocal communication
•  As sensory motor skills develop child begins to
•  Make more purposeful movements – act on things and
move in their environment
•  Babble with more varied speech sounds (this is also
influenced by changes in anatomy)
•  People respond to all these behaviours as
meaningful – provide a linguistic (language) map
of the interpreted meaning.
•  E.g. child looks towards drink – partner says “Oh, You
want a drink”
•  People use gesture and talk about what the
child is interested in and attract the child’s
attention to what they are talking about
(shared attention)
•  As sensory motor skills develop further (often
about the time the child is sitting / moving
away from adult) child begins to
•  Imitate gestures and vocalisations
•  Use gestures to communicate
•  Shows objects/ pictures to communicate
•  Sequence movement to actively gain
partners attention and indicate message
•  If sign is home language – begin to sign
•  People respond to all these behaviours as
meaningful – provide a linguistic (language) map
of the interpreted meaning.

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 5
 July, 2014

Typical development of communication Learning to communicate

•  Spoken language communication
•  Sensory motor skills develop for more
controlled speech sound production
•  Initial spoken words are approximations,
often only familiar partners understand
•  Sufficient experiences of language used in
meaningful contexts to work out the meanings
of words and sentences
•  Need to have the AH HA moment!
•  Natural feedback to child’s attempts using
words helps the child clarify the meaning.
•  First words may have overgeneralised /
undergeneralised meanings
•  Happens during real life interactions
•  Parents & others
ü  Model communication throughout the
day
ü  Expect that their child’s behaviours are
meaningful
ü  Respond to their child’s behaviours as
meaningful
ü  Shape more specific behaviours
ü  Expand the child’s communication
towards the adult form

Learning to communicate Learning to communicate

•  Parents are generally •  Children generally
–  Competent users of the spoken language, –  Have ample opportunities to practice
gestures & body language of their
–  Receive natural (meaningful) feedback
community
about their attempts at communicating
–  Have intuitive knowledge of their
–  Gradually work out what communication is
communication system
about and how to use it.
–  Teach the complex skill of
–  Integrate all the skills they require
communication as they go about their
daily life
It is the families own system of communication Learning to understand and use language is a process
that they are “passing onto” their child.

The challenges learning to communicate Children who have cerebral palsy

for the student with CCN
•  May experience difficulty
•  Understanding the child’s current communication & with any one or a number
challenges learning to communicate
of these components
–  Receptive and expressive
–  Gestural & speech
–  Variability of responses •  Likely to experience
challenges with sensation
•  Separate out understanding spoken language from and movement
cognitive understanding (with visual input).
•  Facial expression
•  Body language
•  Identify challenges assessing children with severe
•  Gesture
motor impairments until have a method of
communication •  Speech
•  Writing

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 6
 July, 2014

Speech for Children with CP

Cerebral Palsy
•  Key issues affect movements available for
communication, e.g.
–  Set patterns of movement
–  Associated reactions
–  Sensory seeking or avoiding movements
•  Difficulty spontaneously developing and using
typical gestural and spoken communication.
•  “Different” movements may be
misinterpreted / difficult to understand by
partners
•  Disassociation and stability for graded oral
movements (need to look at whole body)
•  Postural control for respiration and phonation
•  Dysarthria
•  Dyspraxia
•  Oral sensory feedback
•  Language impairments
•  Associated difficulties e.g. Hearing impairment
•  Other communication difficulties, e.g. stuttering,
developmental articulation difficulties, delayed language development

Speech intelligibility is influenced by

•  Context / knowledge of topic “I dot a dell”

•  Knowledge of partner – familiarity with
–  Speech patterns
–  Likely words / topics

•  Appropriate language and pragmatics

•  If you were at the beach with me
•  Speech production
–  Intonation yesterday and we were walking along
–  Syllable number picking up ……
–  Accuracy of vowels
–  Accuracy of consonants
–  Voice quality
–  Fluency •  “I got a shell”

Aim Long term aim for all children

For the person to meet his/her varied Understand other people
communication requirements as
•  intelligibly and
•  specifically
•  efficiently Being able to say
•  independently
•  in as socially valued a manner what I want to say,
as possible
To understand others and to be understood. to whoever I want to say it to,
whenever I want to say it

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 7

Enable individual to
more fully and
effectively participate in
various social roles
Solutions include Speech & AAC
(Augmentative & Alternative Communication)
Probable effects of AAC on speech
•  Share the research that AAC
–  does not prevent development of speech
–  studies suggest AAC may enhance speech and/
or language development
•  But also need to understand
–  Why AAC does not stop speech development
–  How AAC may facilitate speech development
Gayle Porter & Linda Burkhart
ISAAC Conference, Lisbon Portugal
July, 2014
Problem-solve the circumstances required
to enable every child to meet his/her
varied communication requirements
•  To understand others & express self
•  Full range of
–  Purposes (e.g. ask questions, complain, comment)
–  Messages, topics
–  Social roles (e.g. student, sister, friend, employee)
–  Partners
–  Environments and physical positions
•  Express individual personality
AAC may be suggested when
•  Adding AAC to speech assists
understanding
•  Speech is likely to be significantly
delayed
•  Speech is difficult to understand – AAC
as a back up system
•  Limited speech – AAC main method of
communication
Remember
l  The
purpose of speech production is
communication
l  Theability to use language is important in
terms of how it enables us to meet our
communication requirements
l  Communication is the engine that drives
language
Martine Smith (Agosci conference, Sydney 2003)
and speech
8
 July, 2014

Multi modal communication Everyone uses AAC !

We all use AAC when external or
•  We all use multiple modes to communicate.
internal constraints limit the
•  Choose the most effective method to “get effectiveness of our spoken language.
our message across”
External constraints Internal constraints
•  Different modes of communication may be e.g. e.g.
more or less effective to communicate
•  Noisy environment •  Laryngitis
–  different types of messages
–  in different situations •  Over distance •  Complex
–  with different partners •  Other person does communication needs
not understand your
language

Noisy environment Over distance

Foreign speaking Country Laryngitis

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 9
 July, 2014

Complex Communication needs

•  Difficulty using speech to meet all varied
communication requirements
•  Speech not effective to get message across
more frequently
•  Need to use other methods more often
•  Worth investing in AAC system to support
more effective communication
Give participants a choice
•  Choose 50 spoken words that you can
use for the next week
OR
•  Pen and paper / AAC system that lets
you say whatever you want to say
•  For children with CCN we do not need
to make this choice – use both the
words they can say and the AAC system

“Hidden” difficulties What can you guess?

•  “I understand everything she says”
•  So what is she saying?
•  Who is she talking with?
•  How many ideas, thoughts, feelings,
opinions, stories are being left unsaid?
•  Messages in infancy tend to be limited
to the here and now – basic messages
easier to guess
•  As children develop they begin to think
messages that are much more difficult
to guess.
–  Communication for more than “What do
you want?” or What’s wrong?”

Selecting a communication mode to suit the requirements “Just because you

know me doesn’t mean
Situation: Lunchtime - cup on a table you can read my mind
Message: I want a drink or can express my
Message: I want a different drink words for me.”
Message: My drink is too cold
Message: Peter drank all of my drink Melinda Smith, “It all comes back to
Message: Last night I had a Pepsi-Max understanding that not
2011
being able to talk
Situation: Outside in playground
doesn’t mean you have
Message: I want a drink nothing to say.”

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 10
 July, 2014

Autonomous communication
What do you want to do?
•  Being able to say what I want to say, when I
want to say it, to whoever I want to say it to

NOT the same as choice making

NOT the same as answering a YES / NO

question

Yes & No
Being able to answer Yes / No Multi-modal communication
is very useful
-  quick responses
-  confirm messages •  For child’s self-esteem, personality
-  to access communication
display and cognitive development we need to
value and respond to all their
messages.
Asking yes / no
questions can •  Children are very sensitive to the
also be very limiting. attitudes of people around them.

Child can only respond to

the other person’s ideas
and suggestions.

Combine AAC & Speech

Interventions
•  To enable child to meet their current
communication requirements PROMPT
Prompts for Restructuring Oral Muscular
•  Stimulate further development of Phonetic Targets
communication, language, literacy and
(where possible) speech.

•  Support autonomous communication: to

enable the child to learn to say
whatever they want to say to whoever,
whenever

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 11
 July, 2014

Creating an Spoken Language Spoken Language

Aided Language
Learning
Environment
Spoken Language Aided Language

Different pathways to autonomous communication

School age children attending CPEC extended education program
Total N = 45

Aided Language Aided Language

Spoken Language (Spoken Language)
(Sign language) (Sign language)

Development over time

“At the beginning (13 months) Patrick had minimal verbal skills (only 2 words -
'mum' and 'dad') but it was obvious that he wanted to participate in what was
going on around him in a more active way. The introduction of AAC (in his case
a communication book with multiple smaller displays for specific activities
such as eating etc that could be easily used in limited spaces) was hugely
liberating for Patrick and for us as a family. Patrick was able to contribute
to conversation, not just with yes and no, but to actually make independent
statements himself and lead the conversation. This really helped to build his
self-esteem and make him even more motivated to try harder, not just in
communication but all activities.
I can certainly say that AAC was a major step forward for all. I can also say

Different methods to access AAC

that using AAC did not stop Patrick from trying to communicate verbally, as it
is simpler and easier to talk. By the time Patrick was 4, he was fully

systems
communicative verbally. He is now (7) fully understandable across a whole
range of situations including a mainstream primary school, where he very
keenly contributes to class discussions.
I am so grateful for the opportunity given to us.”

Donna (Patrick’s mum). NICE discussion forum Re: AAC in Conductive Education
11/11/04

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 12
 July, 2014

Different aids for different purposes Range of possibilities for

communication at ANY TIME
•  Selecting from objects
•  Informal auditory scanning
•  Activity displays
•  General interaction displays
•  Step communicators
•  Communication book
•  Speech generating devices

Selecting a communication aid

It is not possible to rely on a
•  Hardware
High-tech device as the only option for –  Paper, dedicated device, PC, tablet, iPad
communication –  Size, shape, display, battery, memory, processor speed,
Bluetooth, IR, WiFi, mounting, stand, durability, LOOK
–  Possible access methods
All people who use Aided AAC require a light •  touchscreen, keyguards, auditory/visual scanning, eye-gaze
(paper) tech option –  Computer access / other programs / cool stuff!

•  Software program
–  Options to support communication and language,
•  Vocabulary organisation, navigation, symbols, word prediction,
rate enhancement, word morphology, coding, etc
–  Options to support access / layout, e.g. button spacing
–  Customisation and programming options

•  Language organisation / page set(s)

Hanen tips Start with the Whole System

But Teach Systematically
•  Follow child’s lead, Abandon fixed agenda
•  All Hanen tips are based on current research which shows that
parents have the power to boost their children’s language:
–  Make it easy for their child to start conversations • Families report frustration:
–  Respond with interest to whatever their child tells them,
with or without words
• of
When only given a limited amount
vocabulary (too little)
–  Talk frequently with their child about things of interest to
the child
–  Have conversations with their child that go back and forth a
number of times
–  Talk at a level that their child can understand and learn from
• system
When told to just use the whole
to say whatever they say
(not too complex or too simple)
with their voices (too much)

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 13
 July, 2014

Teaching Patterns Teaching Patterns

•  Identify Patterns in the
System
•  Select Patterns to teach
based upon child s language
level and adults personality
styles
•  The brain stores memories as patterns
•  The brain retrieves memories through
patterns
•  Patterns enable learning large amounts of
information without memorizing details

The Brain is not a Video

•  Teach / Coach use of one
pattern at a time (partners) Recorder

The Brain is Pre-Wired to

Look for Patterns and
Patterns Can be Visual, Spatial,
Comparisons to What is Known Auditory, Tactile, Kinesthetic,
Temporal, Procedural, Cognitive,
Linguistic, Multi-Modal, etc.

Languages have patterns We don t learn language by

memorizing the dictionary
• Syntax / grammar
• Word forms (tense, plurals, etc.)
• Semantic meanings
• Pragmatic use
• Interactional patterns
我想那
Я хочу, чтобы
Eu quero que
‫ﺃأﺭرﻱيﺩد ﺃأﻥن‬
Je veux que
I want that
Θέλω ότι Ich möchte, dass

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 14
 July, 2014

We learn language patterns Patterns in AAC Systems

through use •  May be based upon
– how vocabulary is organized
– coding of similar vocabulary
– communicative function
– semantic groupings
– use in natural contexts
– layout - motor pattern

Teaching Partners Using Teaching Partners Using

Patterns Patterns
•  Limit complex written or oral
•  Teach them to fish!
explanations
•  Support spontaneous
•  Teach them to follow patterns
use throughout the
• Rather than memorizing where day
vocabulary is located or learning to •  Support habits for
say specific messages
autonomous
• Uses recognition instead of recall communication at any
memory time

I did it

Patterns in PODD as an example 12 Early Functions

Your turn
I’m done
I’ll help you
Look at me
•  Start with teaching how to say
quick core words in natural
contexts throughout the day

•  The language level of the PODD

book guides the partner in what
to model

•  The idea is to let partners feel

the experience of how patterns
lead you to what you want to say
(Not just tell them)

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 15
 July, 2014

I’m finished I am finish (-ed)

20 Expanded Functions
70 Expanded Key Word
You are not finished
I’m just kidding
You are not finish (-ed)
You can do more
more please
Watch me, I am do (ing) more

You need to finish do (ing) that now

Complex Syntax I do not know how to do it

She forget (-s) how to do it

In trainings, we ask people

I will help her do some first

to use the practice books

to see what they could say
in natural contexts
throughout the day from
page 1a and 1b
(Quick Core)

Select One Navigational Learning Patterns

(pragmatic function) Give an Opinion
Pattern

OR

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 16
 July, 2014

We often ask children what’s

Learning Patterns wrong? But that doesn’t help child
Complain learn to complain
•  Instead of asking are you tired?
•  Model how they could say it
–  Linguistic Map
•  Put word on to what you see
–  Oh, you look very tired
•  Can add the word word maybe
–  “maybe something s wrong, maybe you are
tired”

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 17
 July, 2014

Learning Patterns
Request an Activity

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 18
 July, 2014

I want vs. Do you want? Catch Yourself and

•  As adults, we don t often request things of Develop a New Habit
children
•  We often say: Do you want a book? (or It is
time for a book) Not I want a book •  Think of something you would typically say
•  We have to consciously model the request Do you want _______?
•  If child doesn t really want that, they are now
on activity page and can request something •  Turn it around and say I want ____ .
else
•  Also model requests from other people nearby
for the child to observe •  If Kid is reaching for something, say Oh I
think maybe you want _____ .

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 19
 July, 2014

Relating Information

Let the Level Book Guide You as Expanded Functions More to say

to What to Model

•  Patterns in early books are used and

expanded upon in later books
•  Books progress through increasing levels
of syntax, semantics, discourse and
interactional patterns
•  Appropriate level book allows you to
model just slightly above the child s
expressive level

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 20
 July, 2014

I’m telling you

Expanded Functions Expanded Functions
It’s already happened
something
Special Event

Expanded Functions child: birthday party

partner: You went to a birthday party
Expanded Key Word Special Event

I (past tense) went to a

Expanded Key Word

birthday party
When did you go to a
birthday party?
Complex Syntax

Navigational
Side Panel
from any page

Special Event

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 21
 July, 2014

Complex Syntax I (past tense) went to his birthday party

Who did you go with to the birthday party? Patterns within a Page
Predictably Associated Vocabulary

Patterns within a Page Turn the Page - Additional

Predictably Associated Vocabulary Related Vocabulary and List

Patterns within a Page Turn the Page - Additional

Predictably Associated Vocabulary Related Vocabulary and List

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 22
 July, 2014

Patterns within a Page Let s try it! Opinions Section

Predictably Associated Vocabulary

Turn the Page - Additional Let s try it! - Opinions Section

Related Vocabulary and List

• “I think he is cute!”

• “I think he is ugly”
• “I think he is handsome”
• “I think he is gross”
• “He is cool!”
• “I love him”

Let s try it! - Opinions Section Same Patterns are used in

PODD on SGDs
• “You are unbelievable!”
•  What other opinions can
you give?

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 23
 July, 2014

Same Patterns are used in Plan for communication

PODD on SGDs AT ANY TIME
•  Autonomy to communicate
whenever I have something to say

•  According to own intentions

–  Right to to choose when to communicate
(or not)

Habits to support autonomous FIRST STEP: Establishing

communication
•  Routinely ensuring the AAC system
is readily available for use ALL THE
TIME
–  Prepared for communication AT ANY TIME
•  Providing enough time for the
person to communicate their own
message in the manner / words they
prefer
Healthy AAC HABITS
•  Communication AT ANY TIME
–  AAC is child’s VOICE
•  Problem-solve and practice having AAC
systems with child AT ALL TIMES,
EVERYWHERE.

General interaction displays

Strategies to transport book
•  Provide general vocabulary to
communicate across a range
of activities & between
activities.
Prepared for
•  Say a LITTLE AT ANY TIME communication
•  Limited vocabulary – used
alongside activity / topic
displays. Multiple strategies for
•  New partners practice
communication at ANY TIME
HABITS while preparing to
introduce more complete
personal AAC system Where is my “VOICE”?

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 24

Grade your expectations
•  Don’t need to model it all right now!
•  Have more there to be prepared for less
predictable communication opportunities
(maximise language learning in meaningful contexts)
•  Gradual expansion of use
–  First just model quick chat (PODD first page)
throughout the day
–  Then select one type of message / communication
function to use throughout the day, e.g. opinions,
something’s wrong, Let’s go…
–  Add functions / messages / branches / section / -
Then another ……..
Modeling and coaching in the real
world!
•  Communication happens within the mess of
living a family life
–  Not a game or activity that you fit into your day
–  Communication happens when you’re busy doing
other things
–  Pragmatic cues to communicate vary
–  Physical positions vary
–  Environmental clutter
–  Other responsibilities
–  Etc, etc
CPEC parent and child
group programs
•  Holistic program provides opportunities
to model during activities where the
primary focus not communication.
Gayle Porter & Linda Burkhart
ISAAC Conference, Lisbon Portugal
July, 2014
Different learning styles and speeds
•  Grading expectations using the whole system allows
people to progress at own speed
•  Can jump ahead of expectations
•  Some families start using whole system quickly
•  Jump in and give a try
•  Other families take more time / confidence to try
•  Sometimes need to come in a target new learning, getting it
correct, confidence to try, life’s intervening!
•  March to July 2014
•  Variation between carrying book and using first page, using a
few branches / different messages in familiar contexts, to
jumping in trying all sorts of messages in all contexts
Modeling in the real world!
•  Need to model within real contexts where
communication is not the primary activity
•  Model coming in and out with communication
–  Child watching TV, mum doing the laundry
–  Daily routine and activities
–  Varying messages
–  Varying physical positions
–  Responding to child’s possible communicative
behaviours
•  Linguistic maps, Problem solving meaning, Co-constructing
messages
•  Problem solving environmental constraints
CPEC parent and child group programs
•  Group of children
–  Not all focus on one child
–  More need / practice initiating communication
•  Range of models
–  Speech pathologist, OT, physiotherapist, assistants
–  Other parents and children
–  Range of naturally occurring, genuine messages
•  Model Linguistic maps, Problem solving meaning, Co-constructing
messages
–  Range of physical positions
25
 July, 2014

When will my child start

Coaching in the CPEC program
•  Parents repeating (imitating) what staff said
using AAC
•  Stop and suggest, e.g. “Maybe parents could
tell their child what that thought about that”
–  Staff available to shadow light cue parents
•  Supporting families to recognise opportunities
to communicate using AAC
–  Expectant look towards book / Placing book near
parents / Light cue to books
•  Verbal reference what child is doing to help
people recognise possible initiations
using the PODD?
•  From 15 minutes to 4 years!
•  Cannot expect a child to use something they
have not had opportunity to learn
•  Depends on a number of factors including:
•  Number and quality of experiences of other people
using the AAC system to communicate genuine
messages
•  Method of initiation and responsiveness of partners
•  Communication opportunities provided by partners
•  Current understanding of (spoken) language
•  Sensori-motor skills / method to access aid

Child led communication

Development may
•  Easier to talk when already
have something to say!
take time,
•  Establish methods for child to not always smooth!
initiate communication
•  Respond to child initiations
–  Do not demand use!
•  Focus on interaction - trying
to understand each other!
•  Have fun!

Learning opportunities Distance Coaching

•  Lots of receptive input (18
months – 2 years) • Skype, Google Hangouts,
etc. (Share screens)
•  Sensory motor strategies to
develop movements for • Email
communication
–  Task series
• Shared videos on private
–  Sensory program (diet) YouTube channel

•  Specific prompts and cues to

• Phone conversations
stimulate expressive use (only
after lots of receptive input)
• Facebook

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 26
 July, 2014

Tips and Tricks Succes

ses

Successes Supporting the Journey

•  Start with live interaction Ø What parents/ staff are saying:

•  Build rapport
Wow thank you for the training and for helping us understand. It is
Ø  I got a video of a student using his own PODD and me using mine to communicate. This student is amazing—months ago he was running out of the classroom
constantly and couldn’t follow adult-directed tasks, and did not use icons reliably. Now he is spontaneously using >4 icons off the quick words and has “explored”
the PODDS link himself (I haven’t used the “go to” strand often, yet he figured it out!). (SLP working with student)
not just about the communication but about the relationship. The

•  Establish some shared beliefs and

very first day after the training we took our PODD book home and
Ø  “Wow! I was so impressed with the PODD for a high school girl with a traceotomy. We had a 45 minute conversation that could have gone on for
hours” (Summer replacement SLP seeing student for first time)

showed it to Melissa. I guess she had been using it in class for a

Ø  “So I'm sitting at the snack table having snack with my PODD and my speech group minding my own business when one of the aides in the room
goes up towhile
Mike (onebecause sheingave
of the other students the room)uswithaherbig
PODD smile
book overand pointed
her shoulder (she just to More
finished the PODD totraining
Saythree days
understandings
earlier ) and she pointed to "more to say" and said to him "I have something to tell you."  She flipped to page 2a and pointed to "I want (to do an
That Mikewas the beginning ofatour journey. Three
Mike for months later, we now
activity)" and said "We're going to do an activity."  She flipped to page 11a and pointed to "something to eat or drink" and said, "It's time to eat.  Go
to the table.“ got up and joined me and my students the table. Now I've known about 5 years and have been his SLP quite a bit of

•  Work with the whole team, not just the family

that period and at the beginning of this year had to recommend to his mom that we discontinue direct service since his communication skills were
unchangedtalk and
since I first laugh
worked with him. with
Same few our daughter
words, who has
“All done” and “more” were never
his signs, and hesaid a word
could choose in10her
from about icons to get
some things he might want.  So Mike sits down next to me and I say, "Hi Mike, what are you doing here?" expecting just a smile. Well Mike reaches
up to my14 PODD years of life but she sure has lots to say. As a dad, when I heardbut it was
book and touches "more to say."  I laughed out loud because Mike has never had anything to say let alone more to say
cute so I flipped to page 2a where Mike touched "I want (to do an activity).  I flipped to page 11a where Mike touched "something to eat or drink." 

•  Attending a training together (especially if

We all almost dropped on the floor.  (Later from page 18 he told me both his juice and his cake were yummy.)  Now I have to schedule another IEP
to put himshe was
back on speechretarded, I hadtalking
after the holidays.”  (SLP no about
expectations of her.
a student he had dropped I guess
from services she
due to lack had none
of progress)

of me
Ø  For first time either.
ever, my husband andSome days
son like each other. I amJacknot
When sure
told him whether
the dog was scary withto laugh
his PODD, or cry.
he started I husband loves
to cry. My
dog and Jack always be so mean to it and get in trouble. We never known that he was afraid. But now they talk and my husband gets the PODD so
guess I amsay,still overwhelmed knowing what a delightful daughter I
there is limited local expertise in the AAC
he can talk to. My husband I didn’t know he smart!!!!” (from a mother)

Ø  “
have not known for 14 years. (Father talking about his daughter)
Hi Fran Just want to say thank you for all the work you have done with Maximus. We are using the PODD book more at home. I'm finding out

System)
that I need to catch-up with Maximus on being more fluent with it. As you know we are moving to Concord a big home in a wonderful
neighborhood. Maximus told me with his PODD that he wants a chicken or a duck as a pet, I was kind of hoping for goldfish OH WELL !. But on to
business, I’m going to E-mail laura that I want a IEP meeting before he transfer to the new school. In the new IEP it is the utmost importance to not
only stress but to require that he continues on with the PODDS training, because with it he has proven he can communicate with the world. At home
he tells us he wants to watch tv or the dvd or go the farm, were there's ducks and chickens or Harold the helicopter is up stairs or he thinks brocali is
yucky and stinks—who knew !!” (parent writing to her son’s SLP)

What works well over What doesn’t work well

distance?
•  Selecting and customizing Vocabulary
•  Trouble shooting technical problems
•  Video review with child not present
over distance?
•  Understanding and getting a feel for a child s
movement patterns
•  Understanding and incorporating strategies to
deal with some sensory challenges

•  Live coaching of partners interacting directly •  Trying and tweaking a range of access methods
with a child •  Modeling in natural contexts for partners
•  Repeated contact •  Prerecorded video works better than real time
•  Team meetings coaching with very active or shy children

Techniques Update Information

•  Share information and video ahead of time
•  Have a clear focus for the session
•  Same strategies as live, but in smaller
increments
•  Frequent repeated contacts instead of long
conversations
•  Bluetooth, wireless head set for partner
•  Describe what you have tried in terms of
communication strategies since our last visit:
•  How did the child respond?
•  What were some of the successes and positive
outcomes?

•  Future - remote control surveillance type •  What problems did you run into?
camera - only used during live interactions!

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 27
 July, 2014

Update Information
Quick Language Sample
•  List some examples of messages the child has Child Initiated Only
communicated:

•  List some examples of the types of messages

that are modeled for the child using the PODD
or other AAC system, on a regular basis:

•  Language samples

Language Sample Forms Update Information

•  What would you like to focus on as the next

steps for the child?
•  What would you like to focus on as the next
steps in learning for the team?

•  What are your main objectives for this

session?
•  Major concerns at this time:

Parents Supporting Parents

Family Led Groups
•  Group of families with children who have
similar challenges
•  Compatible personalities of parents
•  Kids using similar AAC systems
•  Range of ages - parents of older students
supporting those of younger children
•  Keep group to a manageable number and have
one parent willing to handle details or delegate

Gayle Porter & Linda Burkhart

ISAAC Conference, Lisbon Portugal 28

Activities
•  Group family outings
•  Parents switch kids during outings and use AAC
to talk to each other s children
•  Mom s night out - emotional support
•  Sharing strategies to collaborate with school
teams
•  Attending each other s IEP meetings
•  Inviting a few school team members on outings
What makes a good
Facebook Group?
•  Closed group of families with similar needs and
beliefs (narrow focus)
•  Dedicated professional(s) to monitor, comment
and encourage regularly (may limit number)
•  Everyone uses the files section to store
responses to Frequently Asked Questions and
annotated lists of web links
•  Members comment on old posts to bump them up
to the top when there is a relevant discussion
that has already taken place.
Additional Challenges with
Distance Consultation
• Problems can escalate - you may not pick
up on issues in a timely manner
• Challenging and confusing for parents
when there are local people who are
actively advocating against the child using
the AAC system - undermining parent s
trust
Gayle Porter & Linda Burkhart
ISAAC Conference, Lisbon Portugal
July, 2014
Facebook
•  Easy accessibility - People are often already using
Facebook
•  Don t need to check a separate web page
•  Can learn by listening to dialog of others
•  Can find others who are facing similar challenges -
some who are farther along the path of using AAC
with their children
•  Cautions: Some people may use it to make
inappropriate statements. I have found if it is a
strong group with clear shared ideas, that this can
start a productive and positive conversation
Facebook (Professionals)
•  Encourage families to post success and videos if
they are willing. Videos have been fantastic
motivators!
•  Always try to state the positive before giving
advice
•  Empathize with and support families through
challenges
•  As a professional, type your posts in Word first
to spell check and make sure you want to say
that before posting!
Ideas
•  Important to locate and build local knowledge
and support
•  Build the knowledge of the family
•  Help families find other families to support
each other
•  Connect families who are more experienced
with new families
•  Be a good listener
29

Engaging families with AAC is a
Collaborative process
•  Listen carefully, not just to the words but what may
be underlying the words
•  Ongoing encouragement and practical support
•  Enthusiasm will come and go, especially if child
requires a longer period of receptive input before
expressive use that adds to family interactions
•  Once child begins to use AAC it becomes easier,
because their autonomous communication reminds
partners why they are making the effort.
What have you found helpful in learning to
use AAC?
•  I have found the use of the books in-group great.
It has really helped me to cement the ideas and
use into our home life.
•  I found the communication sessions handy, as it
gave a lot of context as to why we use the books.
What have you found helpful in learning to
use AAC?
•  The most helpful way we’ve found to learn AAC
has been through the hands-on support we receive
at CPEC. The constant use, demonstration and
total immersing of oneself and the group into the
use of AAC has been the strongest way in which
we’ve learned to use it.
Through this constant use by the therapists and
group participants, I’ve gained confidence in using
our AAC.
Gayle Porter & Linda Burkhart
ISAAC Conference, Lisbon Portugal
July, 2014
What have you found helpful in learning to
use AAC?
•  Evening information sessions provided helpful
background information and understanding of AAC.
•  Access to the PODD books and ALDs at CPEC made it
easy and simple to implement practically.
•  Ready availability of Speech Therapists at CPEC who
are trained in AAC.
•  Use of it consistently in Group Sessions.
•  The fact that every other family at group is doing it.
What have you found helpful in learning to
use AAC?
•  The information sessions were useful and it was
good to start to use AAC gradually – Gayle and
Teri encouraged us to use the displays first, and
then just the initial pages in the communication
book. I felt Fleur responded pretty well to these,
and my husband was more inclined to use them.
What have you found helpful in learning to
use AAC?
•  In the earliest days of learning to use AAC, we
were advised to just learn to take our PODD
everywhere we went and make it available to
Jeremy at all times. This was a fantastic way to
introduce the AAC into our everyday life, without
the added pressure of having to learn another
language right away. These small adjustments to
everyday life make implementing a ‘new system’
that much easier to adapt to and imbed into our
routines.
30

What have you found helpful in learning to
use AAC?
•  I see now how small steps are crucial in implementing
AAC as it helped us to acquaint ourselves with the
process slowly, in that we were able to slide it into
our routine. Once it becomes routine and the AAC is
everywhere and readily available, we had to overcome
the confidence issue of actually using it and not being
afraid to get it wrong.
•  For me personally, the totally immersion of PODD at
group session was the biggest way in which I began to
overcome the confidence hurdle. At home, I had to
adopt a ‘fake it til you make it’ approach. Basically
this meant that I wouldn’t always be using the PODD
in the technically correct manner, but would push on,
model and model some more.
What advice would you give another family in your
situation, who are just beginning a similar journey?
•  This is daunting. It is going to be hard to get your
head around it, but once you work out that your
child understands not only the pathways but also
the vocab, it’s all worth it.
•  It took me months to realize that Grace could
understand and respond to the material. I felt
that the therapists were trying to be super
positive and lead us to believe that she was
communicating. It was only after I saw her use
the communication at least 10 times, that I
believed them. It shocked me mostly because she
knew her body parts. How did she know that?
What advice would you give another family in your
situation, who are just beginning a similar journey?
•  Do it! It can be frustrating and painful and
inconvenient to carry the books around
everywhere but the benefit of Zac having a voice,
choices and options will be worth it.
•  Get organised – organise your house and stick up
ALDs to maximise the number of times you will
use them.
•  Ask questions when you are unsure of something
or not happy with something…
Gayle Porter & Linda Burkhart
ISAAC Conference, Lisbon Portugal
July, 2014
Is there anything that might have better
supported you learning to use AAC?
•  At the start of introducing high-contrast PODDs, to
be talked through the ‘plan’ for progressing to more
advanced PODDs etc. To be able to visualise and
understand what the ‘next step’ will be and look like.
•  I would like to see say a 4-year-old using AAC (so a
couple of years above Grace) to see what they are
able to do with their communication. That means a
child with the CVI book not just the regular book, or
at least that the child that started with the CVI
book and has progressed.
.
What advice would you give another family in your
situation, who are just beginning a similar journey?
•  The other thing is that it is hard to bring the
entire family on the journey. It does take
Grandparents, aunties, uncles, cousins etc. a while
to grasp what you are doing. But if you do it
enough in front of them and make it look as
normal as talking, then they will understand and
use it too.
What advice would you give another family in your
situation, who are just beginning a similar journey?
•  Find a way to bring the AAC along with you
everywhere but don’t try to use it (a bit like
taking a dictionary on holiday with you, don’t open
it, just travel with it)
Once you’ve got it with you everywhere, start to
use it slowly. If you don’t feel confident speaking
in another language right away, practise at home.
Don’t be afraid to get it wrong, just use it,
practise it, model it. J
31

The final thing I want to say goes back
to the title of this post, "Just Do It". I
see people post often about just not
knowing what to do with the PODD, it's
not working for them, they need to
learn it better, etc... My piece of
advice on how to be successful with the
PODD is to just do it.
http://understandinglu.blogspot.pt/2014/02/just-do-it.html
Gayle Porter & Linda Burkhart
ISAAC Conference, Lisbon Portugal
July, 2014
Supporting families with
•  Shared understanding
•  Insight – complex communication needs
•  Motivation – understanding WHY
•  Knowledge of possibilities
•  Guided practice to develop competent use of AAC
(sufficient skills, knowledge and judgment)
•  Practical ideas and support for juggling it all
to “JUST DO IT”
32